Background: Childhood injury rates are higher in low and middle-income countries than in high-income countries. Childhood injuries have not been widely studied in Romania, a middle-income country, because data sources are lacking. Objective: This study presents the first surveillance data of nonfatal childhood injuries from a large children's hospital in Cluj, a major city of Romania. Methods: This retrospective study included review of medical records of injured children of 0-18 years of age treated in a major city pediatric emergency department from 1999 to 2003. Results: In the 5-year study period, 1179 childhood injuries were treated in the emergency department, for an average of 236 patients per year. For the county of Cluj, this represents an annual average injury incidence of 197 per 100 000 children younger than 5 years, 140 per 100 000 children aged 5-14 years, and 135 per 100 000 for children aged 15-18 years. Unintentional injuries represented 77.8% of cases, 18% were self-harm and suicide attempts, and 4.3% were assaults. Conclusion: These trends, among the first reported from Romania, can help identify priority prevention areas.